substance abuse prevention is suicide prevention: the link ... · substance abuse prevention is...
TRANSCRIPT
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Substance Abuse Prevention IS Suicide Prevention: The Link Between Alcohol Use and Suicide Risk
Laurie Davidson, M.A., Manager, Provider Initiatives Programs
Suicide Prevention Resource Center
Sponsored by:
Illinois Department of Public Health; Suicide Prevention Project
Illinois Department of Human Services, Bureau of Positive Youth Development
Prevention First
November 19, 2014
This training is made available by the Illinois Department of Public Health through funding from
grant number 1U79SM060429-01 awarded by the Substance Abuse and Mental Health Services
Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views,
policies, and opinions expressed are those of the authors and do not necessarily reflect those of
SAMHSA or HHS.
The nation’s only federally supported
resource center devoted to advancing the
National Strategy for Suicide Prevention.
Suicide Prevention Resource Center Promoting a public health approach to suicide prevention
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Substance Abuse Prevention IS
Suicide Prevention:
The Link Between Alcohol Use and
Suicide Risk
Laurie Davidson, MA
Senior Project Director
EDC, Inc.
November 17, 2014
Acknowledgements
Jason Kilmer, PhD, University of Washington
Dave Stewart, MPH
Sheila Krishnan, MPH
Kerri Smith, MSW, MPH
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Agenda
Suicide risk and protective factors, and
warning signs
General relationship between AOD use and
suicide
Effects of AOD use on suicidal thinking
Alcohol as a risk factor for suicide
Impact of environmental alcohol prevention
on suicide
The Environmental Management
framework
Poll 1: Your Role/Profession
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Poll 2: Risk Factors
Poll 3: Warning Signs
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Risk and Protective Factors and Warning
Signs
Relationship between Alcohol Use and Suicide
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Proximate Risk Factors for Suicide
Sleep difficulties 92%
Severe anxiety 92%
Panic/anxiety attacks 80%
Prevailing sad or depressed mood 80%
Recent loss of someone close 78%
Alcohol or substance abuse 68%
Feelings of hopelessness 64%
Feelings of helplessness 62%
Hall et al., 1999
Blood Alcohol Level
• .02% Relaxed
• .04% Relaxation continues, Buzz develops
• .06% Cognitive judgment is impaired
Kilmer, 2014
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“Alcohol Myopia”
?
Impelling Cues
Inhibiting Cues
Alcohol impairs information processing,
narrowing attention to only the most
salient internal and environmental
cues.
Kilmer, 2014
Alcohol Myopia
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Absorption and Oxidation of Alcohol
• Factors affecting absorption
– What one is drinking
– Rate of consumption
– Effervescence
– Food in stomach
• Factors affecting oxidation
– Time!
Kilmer, 2014
Time to get back to .000%
• .08%?
– 5 hours (.080%....064%....048%....032%....016%....000%)
• .16%?
– 10 hours (.160%....144%....128%....112%....096%....080%... .064%....048%....032%....016%....000%)
• .24%?
– 15 hours (.240%....224%....208%....192%....176%....160%... .144%....128%....112%....096%....080%....064%... .048%....032%....016%....000%)
Kilmer, 2014
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REM
Stage 1
Stage 2
Stage 3
Stage 4
Kilmer, 2014
Alcohol Use, Sleep, Mental Health
REM
Stage 1
Stage 2
Stage 3
Stage 4
Kilmer, 2014
Alcohol Use, Sleep, Mental Health
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REM
Stage 1
Stage 2
Stage 3
Stage 4
Kilmer, 2014
Alcohol Use, Sleep, Mental Health
REM
Stage 1
Stage 2
Stage 3
Stage 4
Increase in: •Daytime sleepiness •Anxiety •Irritability •Jumpiness
Kilmer, 2014
Alcohol Use, Sleep, Mental Health
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REM
Stage 1
Stage 2
Stage 3
Stage 4
Next day, increase in: •Daytime sleepiness •Anxiety •Irritability •Jumpiness
Kilmer, 2014
Alcohol Use, Sleep, Mental Health
REM
Stage 1
Stage 2
Stage 3
Stage 4
Next day, increase in: •Daytime sleepiness •Anxiety •Irritability •Jumpiness
Next day, feel: •Fatigue
Kilmer, 2014
Alcohol Use, Sleep, Mental Health
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Alcohol as a Risk Factor for
Suicide
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Alcohol & MH as Suicide Risk Factors
• Three patterns identified as co-occurring risk
factors
• Alcohol along with a mental health condition
• Alcohol with other life stresses
• Alcohol use at the time of death
Logan, Hall & Karch, D.
(2011)
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One Way of Thinking
Alcohol
Suicide
Depression
Anxiety
Stress
Alcohol is a risk factor for suicide
– Alcohol increases risk for depression
– Alcohol worsens depression outcomes
– Depression and alcohol risk factors for suicide
– Alcohol a proximate risk factor for suicide
Hufford, 2001 and SAMHSA, 2006; Hall et al., 1999; Hufford, 2001
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Poll 4: Which comes first?
Which comes first?*
Compared to abstainers, increased
risk for depressive symptoms: OR (times
more likely)
- light substance dabblers
- drinkers
- sex dabblers
- alcohol and sex dabblers
- multiple partners
- smokers
- binge drinkers
- heavy dabblers
- sex and drug combination
- high marijuana and sex
- sex for drugs or money
- marijuana
- marijuana and other drugs
- IV drug use
1.86
2.45
2.65
2.91
3.73
3.98
4.03
4.77
5.54
5.83
6.39
7.10
7.29
10.06
*Actual title of JAPH article by Hallfors et al, 2004
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Another Way of Thinking
Depression Alcohol Use
Fergussen et al (2009); Owens & Shippee (2009); Mason et al
(2008); Hallfors et al (2005); Wang & Patten (2002); Brook et al
(2002); Gilman & Abraham (2001); Wang & Patten (2001b);
Hartka et al (1991)
The Alcohol Environment & Suicide
• Lower MLDA associated with 18-21 y.o. suicide
risk
• Increased alcohol consumption associated with
increased suicide mortality rates
• Restricting alcohol availability may reduce
suicide mortality
Brickmayer & Hemenway, 1999; Mann et al, 2006; Pridemore & Snowden, 2009 and Varnik et al, 2006
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Alcohol Prevention as Suicide
Prevention
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Alcohol
Use
Depression
Suicidal
Behavior
Other risk
factors
Recap
• Alcohol constricts thinking
• Alcohol use is a risk factor for suicide
• In adolescents, alcohol may precede depression
(i.e., not a self-medication model)
• Changing the alcohol environment may reduce
suicide deaths
• There is a proven framework for reducing
alcohol consumption and consequences
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Framework for Environmental Alcohol
Prevention
• Access
• Marketing
• Norms
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http://www.alcoholpolicymd.com/alcohol_policy/effects_ep.htm
Limiting Access to Alcohol
• Conditional use permits/land use ordinances
• Regulations or bans on home delivery
• Responsible Beverage Service Training
• Checking age identification
• Beer keg registration
• Alcohol restrictions at community events
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Changing Misperceptions (Norms)
• Social marketing campaigns
• Social norms campaigns
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Enforcement
• Compliance checks
• Party patrols
• Shoulder tap programs
• Enforce MLDA
• Enforce impaired driving laws
• Open container laws
• Etc.
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Discussion/Brainstorm
What are some barriers to implementing
environmental prevention strategies?
What are some possible strategies to
overcome those barriers?
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http://www.healthandlearning.org/documents/environmental_strategies.pdf
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CAPT Resources
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Thank You!
For more information about this webinar, please contact:
Jennifer L. Martin, MSW
Suicide Prevention Project Manager
Illinois Department of Public Health
Phone (217) 558-4081
Fax (217) 782-1235
TTY (800) 537-0466
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